A new OTC constipation treatment
that takes water where it's needed
Dulcobalance® is a new product from the makers of Dulcolax®.
It dissolves in a glass of water then directs it to the bowel,
where it works only on the stool. Dulcobalance®, which
contains macrogol, is not absorbed into the body but uses
natural osmosis to bind water directly with the stool. Plus,
its specific mode of action limits bloating and flatulence. 12
Dulcobalance® does not thicken in the glass and has a
pleasant fruit flavour. As it contains no electrolytes, it is
suitable for people with cardiovascular or kidney problems.
Gentle and effective relief
• Hydrating action
■ Promotes your natural rhythrr
» Dissolves in water
■ Flavoured with fruit juice
ody-Friendly Solution for Constipation
Dulcobalance® Product Information Presentation: Dulcobalance containing 1 0g of macrogol 4000
in a sachet. Dulcobalance containing lOg of macrogol 4000 in a sachet. Indication: Symptomatic
treatment of constipation in adults and children aged 8 years and above. Dosage: 1 to 2 sachets
dissolved in water per day, preferably taken as a single dose in the morning. In children treatment should
not exceed 3 months. Contraindications: Severe inflammatory bowel disease (e.g. ulcerative colitis,
Crohn's disease), oi toxic megacolon associated with symptomatic stenosis, digestive perforation or
risk of digestive perforation, ileus or suspicion of intestinal obstruction, painful abdominal syndromes of
indeterminate cause, hypersensitivity to macrogol or any of the excipients. Warnings and precautions:
Patients with hereditary pioblems of fructose intolerance should not take Dulcobalance. In case of
diarrhoea, caution should be exercised in patients who are prone to a disturbance of water electrolyte
balance (e.g. the elderly, patients with impaired hepatic or renal function or patients taking diuretics).
Pregnancy and lactation: No data is available in pregnant women, therefore caution should be
exercised when taking Dulcobalance during pregnancy. As macrogol is not significantly absorbed,
Dulcobalance may be taken during lactation. Adverse effects: Common: abdominal distension and
pain, nausea, diarrhoea. Uncommon: vomiting, urgency to defaecate, faecal incontinence and bloating.
Very rare: Hypersensitivity reactions including pruritus, urticaria, rash, face oedema, Quincke oedema
ana an isolated case or anaphylactic shock. Unknown: Diarrhoea leading to electrolyte disorders
(hyponatremia, hypokalaemia) and dehydration. RRP (ex VAT): £4.88, 10 sachets Legal category:
P Product Licence Number: PL 00015/0318 Product Licence Holder: Boehringer Ingelheim Ltd,
Ellesfield Avenue, Bracknell, Berkshire RG12 8YS. Date of revision: November 2009.
References: 1 . DiPalma JA et al. Overnight Efficacy of Polyethylene Glycol Laxative. Am J Gastroenterol
2002; 97 1776-9. 2. Data on file.
Have your say
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firstname. surname 77
Cover: Getty Images (Adapted)
LIVING UP TO ITS
PROMISE -WE WILL
HAVE TO WAIT TO
SEE IF POLITICIANS
CAN LIVE UP TO
No news is good news. Like so many
cliches, this well-known phrase is
frequently true - and so is the
reverse. Good news is all too often
no news, so much so that those of us
who trade in news are at constant
risk of becoming jaded cynics.
So it is a great pleasure this week
to be able to announce the
prestigious shortlist for the C+D
Awards 2010 (p22).
It's certainly good news for our
finalists - all 69 of them. Previous
C+D Awards winners have
repeatedly testified to the value of
being recognised: from a self-
confidence boost to team
motivation; and from raised profiles
within local communities to respect
from PCTs, peers and other
The other big announcement this
week was, of course, the dissolution
of parliament - after 13 years of
Labour primacy, the countdown to
the most-hyped general election in
recent memory has well and truly
begun. And in the latest of C+D's
exclusive interviews with the big
three's respective health chiefs, the
Lib Dems have pledged to make
community pharmacy a central
plank of its plans to shake up the
health service (p4).
But whichever party is first past
the post, it will have no choice but to
face the increasing strain on the
public purse and make its promised
NHS overhauls in the context of
budget cuts. So, however many
soothing words politicians use to
woo us in the race to the polling
booths, there is no doubt that
community pharmacy will have to
prove its worth for every penny
The sector is hoping that the
ongoing cost of service inquiry will
make the case for the true cost of
providing an NHS pharmacy service.
But as Hampshire & loW LPC chief
officer Mike Holden reiterates (plO),
community needs to provide more
evidence of its effectiveness.
So as well as being good news
for the finalists themselves, the
breadth of pioneering community
pharmacy practice revealed in the
C+D Awards 2010 shortlist is also
good news for the sector as a
whole. An incoming government
could do a lot worse than to cast its
eye over this showcase for evidence
of what pharmacy is already
achieving - and a taste of what more
it could contribute to improving the
nation's health if it was given more
The C+D Awards 2010 shortlist
proves that, all over the UK,
community pharmacy is living up to
its promise - we will have to wait to
see if politicians can live up to theirs.
It only remains for me to wish, on
behalf of C+D, all our finalists the
very best of luck for the final judging
and announcement of the overall
winners of the 14 C+D Awards 2010
trophies - watch this space.
4 Dispensing error guidelines imminent
5 Script sorting changes slammed
6 Avicenna plans to build own chain
8 Locum warned over supply error
10 Tk ur meds - text to improve compliance?
12 Product and market news
14 Xrayserand Duncan Rudkin
17 Update: motor neurone disease
How to help patients manage their symptoms
19 Practical Approach
Must foreign pharmacists be proficient in English?
20 Jobs for the girls
How women can make it to the top in pharmacy
22 C+D Awards 2010 -the shortlist
Check out the 69 finalists
24 Maximising OTC sales
A seven-step refresher from Trevor Core
© UBM Medica, Chemist+Druggist incorporating Retail Chemist. Pharmacy Update and Beauty Counter Published Saturdays by UBM Medica, Ludgate House, 245 Blackfnars Road, London SET 9UY C + D online at:
wwwchemistanddruggist.co.uk. Subscriptions: With C + D Monthly pricelist £250 (UK), without pncelist £205 (UK). ROW price £365 Circulation and subscription: UBM Information Ltd, Tower House, Sovereign Park, Lathkill St,
Market Harborough, Leics. LE16 9EF. Telephone: 01858 438809 Fax: 01858 434958 Refunds on cancelled subscriptions will only be provided at the publisher's discretion, unless specifically guaranteed within the terms of
subscription offer. The editorial photos used are courtesy of the suppliers whose products they feature We are not responsible for the content of any external websites referred to in this magazine All rights reserved No part of
this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including photocopying, recording or any information storage or retrieval system without the express prior written consent
of the publisher The contents of Chemist + Druggist are subject to reproduction in information storage and retrieval systems UBM Information Ltd may pass suitable reader addresses to other relevant suppliers If you do not wish
to receive sales information from other companies please write to Emily Miles at UBM Medica Origination by ITM Publishing Services, Central House, 142 Central St, London EC1V 8AR. Printed by Headley Brothers Ltd. The Invicta
Press, Queens Road, Ashford TN24 8HH Registered at the Post Office as a Newspaper Volume 273 No 6742
Pharmacy minister: dispensing
error guidelines due this month
EXCLUSIVE Long-awaited CPS guidelines lifting threat of single error prosecutions expected
Mike O'Brien: ensuring pharmacists aren't criminalised is key to government's plan
Lib Dems: star role for
sector in NHS vision
The Liberal Democrats have vowed
to put pharmacists at the vanguard
of an NHS geared towards
preventing killer diseases, following
a general election triumph.
The shift would be supported by a
major shake up at PCT level,
Norman Lamb, Lib Dem health
secretary, exclusively told C+D.
Funding for local commissioners
could be decided by how well
pharmacies and other NHS
stakeholders were commissioned to
improve public health, he said.
This could be achieved through a
QOF linked to the pharmacy contract,
the Lib Dem health chief added.
Mr Lamb said: "The network of
community pharmacies has a really
important role to play in screening
and awareness about a host of health
issues like smoking and obesity."
He added: "At the moment PCTs
stand passively by as NHS money is
diverted to other areas. Instead you
could incentivise them to use the
forces available, including
pharmacies, to make it happen."
Under the Lib Dems, PCTs would
be rebranded as local health boards
with elected patient representatives
deciding policy. Greater primary care
spending would be financed by
wholesale cuts on government
quangos, Mr Lamb said, and by
slimming down regulation. MG
Pharmacists could be free from the
threat of prosecution for single
dispensing errors from this month,
the pharmacy minister has revealed.
Speaking exclusively to C+D, Mike
O'Brien said Crown Prosecution
Service (CPS) guidelines on dealing
with pharmacists making single
errors would be published
"hopefully within the next few
weeks, within April".
The guidance had been due early
this year and its publication follows
criticism from the RPSGB and
shadow health minister Mark
Simmonds over delays on the issue.
Mr O'Brien said he was still
"concerned" pharmacists could be
given jail terms for single dispensing
errors. And ensuring pharmacists
"won't be criminalised" for single
errors was a key part of government's
plan for the sector, he added.
A spokesperson for the DH
confirmed the MHRA, DH and CPS
had been working together to ensure
dispensing errors were dealt with "in
a proportionate way", and that the
guidance was due for release in April.
RPSGB president Steve Churton
said the Society was continuing "to
press for swift and decisive action"
from the CPS, and growing
"increasingly frustrated and
impatient" with the delay.
The CPS has come under
increased pressure to decriminalise
dispensing errors recently, following
the announcement that locum
Elizabeth Lee will appeal her criminal
conviction for a single dispensing
error later this year.
Last month the CPS told C+D that
guidelines for prosecutors to show
leniency if pharmacists made a
mistake were "still being considered"
by the director of public
prosecutions, and would "take as
long as it takes" to be finalised.
RPSGB ups payments
on £12m pension deficit
The RPSGB is set to increase by 85
per cent its monthly deficit
reduction payments to its final
salary pension scheme.
The Society will pay an extra
£67,400 a month effective from
January 2010, on top of the monthly
£79,600 it already contributes to
deal with a scheme deficit valued at
over £12 million.
Following RPSGB Council
agreement last week, this interim
measure will continue until a new
deficit valuation is formalised with
the scheme trustee, who requested
the extra payment.
In a Council paper proposing the
additional payment, Society director
of commercial services and
resources Bernard Kelly said: "The
deficit of the pension scheme is a
liability of the Society, which cannot
be removed and has to be dealt with
in the long term.
"Contributions made now...
should not be regarded as money
lost but as a reduction in the liability
which will reduce the burden in
The deficit was valued at over
£12.2m at the end of 2008, Mr Kelly |
explained, after the trustee brought
the valuation forward from the
following December due to concerns
over the impact of the RPSGB split.
But the Society had argued the
2008 valuation was "not justified"
because of economic instability, he
said, and that a 2009 valuation
would give greater clarity on the
impact of the split.
The trustee had therefore agreed
not to formalise the 2008 valuation j
if the extra interim payments were
be made until the 2009 valuation
A Society spokesperson confirmed
Council had approved the additional I
payments and said minutes of the
meeting would be available shortly. I
The deficit reduction payments
are in addition to the Society's future!
service contribution to the pension
Watch C+D news editoi
Gosney interview Liber
Democrat health secrel
Watch out for video interviews with shadow health ministers at
Script sorting changes
slammed by contractors
'Archaic sorting process' means more bureacracy, say pharmacists
Pharmacists have expressed concern
about the additional workload that
changes to prescription sorting
requirements will bring, calling the
changes "archaic" and "ridiculous".
The changes revealed by NHS
Prescription Services will mean
pharmacies have to separately sort
prescription forms containing
'specials' or individual items with a
net ingredient cost of £100 or more.
Broken bulk items will also be sorted
in this way, as before.
The moves are designed to reduce
errors in pricing by the automated
system and to safeguard
contractors' monthly payments by
allowing increased attention to be
paid to these items.
But pharmacists said the moves
brought yet more bureaucracy.
Anger at 'questioning of professionalism'
Pharmacists have expressed anger
as some manufacturers continue to
request faxed proof of demand
before despatching medicines in
The requests for faxed
prescriptions come despite
agreements at the recent stock
shortages summit for stakeholders
to work together to ensure patients
Keith Sykes, of Newington
Pharmacy, Hull, told C+D: "I am
Ambitious development targets set
by the RPSGB's new professional
leadership body in January are
still to be met as the 100-day
deadline for completion of the
goals draws near.
So far just one of the seven
overarching commitments to
members has been fulfilled,
although three more have been
partially completed as the April 19
The Society said it would release
an update on the pledges, which
include improving awareness and
perceptions of pharmacy and
actively listening and responding to
members, on April 24.
George Romanes, of the Romanes
Pharmacy Group, said: "They have
made a pretty good stab at it
considering what they have to do in
100 days." MH
annoyed at the stance taken by
Novartis that requires me to fax
copies of prescriptions. It takes up
valuable time and calls into
question my professionalism."
PSNC agreed the procedure was
burdensome and other leading
manufacturers said they had no
Novartis said copies of
anonymised scripts helped them
check orders related to patients
needing immediate supply.
Graham Phillips of the Manor
Pharmacy Group in Hertfordshire
criticised the "evermore archaic
sorting processes". He said the
government needed to "do
something about this absurd
bureaucracy and their inability to do
simple things like price prescriptions".
However, other contractors
expressed relief that the changes
might improve pricing accuracy at
least. Lila Thakerar, of Shaftesbury
Pharmacy in Harrow, said she had
decided to sort specials separately
anyway recently after seeing many
incorrectly priced. In some cases she
had been reimbursed in the region of
£1 for items worth over £300. She
said the changes would help
pharmacies who might not be aware
they were being underpaid.
Janet Edginton, PSNC's head of
pharmacy audit, said sorting items
over £100 would "clearly require
additional pricing knowledge by the
pharmacy staff" but that the
committee would produce a list of
commonly prescribed items over
£100 to help pharmacies adapt.
Chemist+Druggist has announced the shortlist for the C+D Awards 2010, in
association with the NPA. From what the judges described as "a really excellent
batch of applications", 69 pharmacists, pre-registration graduates, technicians,
assistants and others made it onto the prestigious shortlist for the third annual
C+D Awards. "We were delighted by the record number of entries to the C+D
Awards 2010," said C+D editor Gary Paragpuri. "They were of an incredibly high
quality and it was wonderful to see such a diverse range of entrants, including
LPCs and PCTs." The finalists will now be invited to join colleagues and community
pharmacy leaders at an awards ceremony in June, when the winners of the 14
trophies will be revealed. To see who made it onto the shortlist, turn to page 22.
The first OTC medicine to treat
heavy menstrual bleeding has
been approved by the MHRA.
Meda Pharmaceuticals plans to
launch the product under the
brand name Cyklo-F in early 2011
as a P product containing SOOmg
NPA slams proposals
The NPA has spoken out against
DH proposals to implement
generic substitution in
pharmacies, saying the changes
are counter to the drive for quality
in health services and less likely to
achieve financial savings than
measures to reduce waste.
Pharmacists could have to register
with the Complementary and
Natural Healthcare Council if they
wish to continue supplying
unlicensed herbal and other
complementary medicines in the
future, following an announcement
by health secretary Andy Burnham.
Services boost custom
Additional services such as MURs,
smoking cessation and emergency
contraception could be responsible
for increased customer numbers
in pharmacy stores, according to a
GSK survey. Fifty three per cent of
pharmacists whose stores offered
the services had seen a rise in
footfall and 22 per cent of those
saw improved retail sales.
GP guide published
Guides for pharmacists and GPs to
help them develop more effective
working relationships between the
two professions have been
published by PSNC, the British
Medical Association's General
Practitioners Committee and NHS
The School of Pharmacy and Life
Sciences at Robert Gordon
University, Aberdeen, is the first
UK institution to offer a masters
course allowing internationally
qualified pharmacists to apply for
UK pharmacy pre-reg training
Read C+D reporter Chris Chapman's Avicenna conference blog
As the pharmacy
white paper marks its
second birthday, how
well has it been
"The white paper has been a missed
opportunity for pharmacy. What
started out with the best of
intentions has been woefully
underfunded by government."
Graham Jones, Broadway
Pharmacy, Hungerford, Berkshire
"Not at all. The potential is there and
the theory is good but there seems
to be no emphasis on it from local
PCTs, which is where the money for
it is coming from."
Geoff Ray, Total Health
Pharmacy, Watton, Norfolk
Exceeded expectation 0"V„
Delivery on target A
Behind in areas 55%
Armchair view: It's a damning
verdict for those charged with
delivering the white paper, as not a
single voter thought implementation
targets were being met.
Next week's question:
Could text message reminders help
patients take medicines properly?
Avicenna set to form
chain in London area
EXCLUSIVE Purchase of significant number of pharmacies 'imminent'
c hris. email@example.com
Independent pharmacy group
Avicenna is set to become a multiple
pharmacy chain "imminently" by
acquiring premises in the London
area, C+D can reveal.
The group is looking to form its
own retail chain following continued
growth, which saw an operating
profit of £1.5 million last year and
membership expand to 1,250
members, chairman David Gration
told the Avicenna Conference in
Kerala on Tuesday.
Speaking afterwards to C+D, Mr
Gration revealed the move to
acquire pharmacies for the chain
would be "imminent", and said he
expected "a significant number"
to be purchased for the company.
"You can see the ambition of the
company is big - it's not going to be
just one," he said.
Avicenna director Uma Patel told
C+D the number of pharmacies
acquired would depend on price, and
he declined to be drawn on a
timeline. However, he added that
the group had the financial reserves
to make a significant purchase. "If a
Uma Patel: "If a chain of 20 comes up
at the right price, we'll buy."
chain of 20 comes up at the right
price, we'll buy... we certainly have
the firepower," he said.
When asked about potential
locations for the chain, Mr Patel said
the pharmacies were likely to be in
London or the surrounding area. He
said: "A good quartermaster says
you should keep your line of
communication short... within the
M25 or a commutable distance."
Proposals may ease foreign
representatives have backed
proposals that could make it easier
for the sector to take on foreign
The NPA, CCA and Day Lewis all
welcomed an independent body's
recommendation that the
government reinstate community
pharmacists to its shortage
If the Home Office accepts the
Migration Advisory Committee's
(MAC's) suggestion, the sector will
once again be able to freely recruit
migrant workers from outside the
European Economic Area (EEA).
Day Lewis head of HR Stephen
Wellings called the MAC's
recommendation "a victory for
But the Home Office decision will
now have to wait until after the
General Election, following the
dissolution of parliament this week.
The NPA said it hoped the
incoming government would
recognise the increased demand for
community pharmacists due to
rising pharmacy numbers, longer
opening hours and new services.
NPA head of external affairs
Stephen Fishwick said: "Community
pharmacy is taking on an ambitious
change programme and needs the
government to take a suitably long
term view on workforce."
Pharmacy bodies slammed the
removal of community pharmacists
from the shortage occupations list
last summer (C+D, August 1, 2009,
p8), when some students were left
unable to take up pre-reg
Avicenna is already piloting its
ACE Plus 'virtual chain' concep
providing head office function:
for independent pharmacies, a
will roll it out from July, CEO
Salim Jetha has said.
The group said the future of
the independent sector lay in
banding together to form virtui
chains that could cut down
paperwork by providing
centralised head office support.
PSNC chief executive Sue
Sharpe agreed that such
developments were critical to
the survival of the independen
Speaking exclusively to C+D,
Mr Jetha said the ACE Plus
service had been piloted in more
than 40 pharmacies, and that he
hoped around 10 per cent of
Avicenna's membership would
"Trials have shown this is
working, that the membership is
happy," he said.
Actavis has confirmed that it has
withdrawn its application for its
trimethoprim preparation Cysticlear
to switch from POM to P, as press
reports suggest MHRA moves to
switch the drug have been stopped.
The switch application, originally
made in 2005, gained strong support
from the pharmacy sector including
However, the application to
switch trimethoprim from POM to P
raised concerns about overuse of
antibiotics and the risk that
pharmacy customers would not
follow treatment instructions.
GP magazine Pulse reported this
week that the government had
stepped in to halt the switch.
Actavis said it would be robust in
pursuing its POM to P pipeline in
other therapeutic areas. CMA
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Enter the swine flu pandemic survey online
Warning over supply error
Locum dispensed 10 times required amount, RPSGB panel told
A pharmacist from Holywell has
been given a warning by an RPSGB
disciplinary panel after supplying
2,100 methadone 5mg tablets,
which had been erroneously
prescribed by a CP, to a patient.
Working as a locum pharmacist
at Runcorn Late Night Pharmacy,
David Sheppard dispensed the full
amount on or around July 6, 2006,
for a patient who was going on
holiday to Ireland for three weeks.
The tablets amounted to 10
times the methadone required for
the holiday, or more than six
months' worth, and are now
believed to have been sold on the
black market, the RPSGB panel heard.
The disciplinary panel was told
Mr Sheppard dispensed the amount
"without checking it was correct".
Mr Sheppard denied that he had
failed to adhere to accepted
standards, saying another
pharmacist had checked the
prescription and that he considered
that was sufficient.
But he was found guilty of failing
to adhere to accepted standards in
a way likely to bring the profession
into disrepute or undermine public
confidence in the profession. The
disciplinary panel issued a warning
that will remain on Mr Sheppard's
record for five years.
The panel said that, although the
other pharmacist had checked the
prescription, Mr Sheppard should
also have done so.
However, panel chair Patrick
Milmo QC said this had been a
"single, isolated incident in a long
and unblemished career".
He added that Mr Sheppard had
made "good efforts to improve his
practice" and was now a "highly
scrupulous and conscientious
C+D News Survey
As the DH promises a review into the response to the
swine flu pandemic, C+D asks how it was for you
sales pick up
The market for pharmacy business
sales is picking up, but some
analysts have warned obtaining
funding for the deals is still
David Reissner, head of
healthcare at Charles Russell, said
the law firm had clients looking to
get into pharmacy for the first
time and he anticipated increased
sales. Finance company Pharmacy
Partners had seen more activity in
pharmacy acquisitions recently, in
particular from independents.
But Umesh Modi, a pharmacy
financial advisor at Silver Levene,
warned difficulties getting loans
were having an impact.
an iPod Shuffle
Return the survey by April 23
and be entered into a draw to
win an iPod Shuffle!
1. Overall, how well was the swine flu
response in your area organised?
a) Very well organised
b) Quite well organised
c) Quite disorganised
d) Very badly organised O
2. How well did your PCT keep you informed
and updated throughout the pandemic?
a) Very well, with direct communications
b) Quite well □
c) Poorly □
d) It didn't communicate with us directly C3
3. How well did your LPC liaise with the PCT
during the pandemic?
a) Excellently L"")
b) Reasonably well D"
c) Adequately G
d) Poorly □
4. How badly were patient services disrupted
at your pharmacy during the pandemic?
a) Seriously disrupted J
b) Affected, but not seriously O
c) We had to work harder, but they weren't
d) No disruption to us or to services □
How were they affected?
5. Were you and your staff offered swine flu
a) Yes □
b) No □
If yes, did you choose to have it and why?
6. What changes could have improved
pharmacy's response to the pandemic?
a) More communication to pharmacy O
b) A national response plan for pharmacy CJ
c) Other, please state
7. Have you made changes to prepare for a
future pandemic, eg creating a pandemic
a) Yes □
b) No □
If yes, what changes have you made?
You can also enter the survey online at
www.chemistanddruggist.co.uk. Enter by
April 23 for a chance to win an iPod Shuffle.
Daytime phone number:
Post this completed page to: C+D, 8th Floor, Ludgate House, 245 Blackfriars Road, London SE1 9UY or fax it to 0207 921 8132.
All complete entries returned by April 23 will be put into a draw for the iPod Shuffle
professionals. Our emails may also include information from other carefully selected
companies including promotional materials from pharmaceutical companies that may be of (_} Please tick this box if you are happy for UBM Medica to share your details with carefully
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- 1 >-i
INTRODUCING A PFIZER NEUROPATHIC PAIN PATIENT SYMPTOM
AWARENESS PROGRAMME "YOUR MYSTERY PAIN"
Have any of your patients told you that pain crawls over their skin? Chronic pain that is hard to
treat can become frustrating. You can aid your patients by asking them to describe their pain,
which will help you to identify those with neuropathic pain.
The Charity for Healthier Backs / ,.
YOUR PATIENTS CAN GET MORE INFORMATION AND SUPPORT BY VISITING
TALK TO YOUR PATIENTS ABOUT NEUROPATHIC PAIN AND THE TREATMENTS AVAILABLE
06-00143A2a | © Pfizer Limited 2009 All rights reserved. | Date of preparation. July 2009
Read the latest news online
1 0.04.1 mvw.chemistanddnigglstcauk
Text messages latest weapon in
battle for medicines adherence
As improving compliance remains a key target for the NHS and pharmacy, Zoe Smeaton finds
out how an IT system house has shown texting patients might be the next step
Message Dynamics: how Cegedim Rx's
repeat prescription service works
call length to remind patients their repeat is due
per month cost
per 1 00 patients
increase in dispensing
of required medicines seen
With its promises to help save the
NHS money and boost patient
wellbeing, improving medicines
adherence is rightly high on the
health agenda. And although an IT
system house might not be the most
likely place to look for inspiration on
the matter, Cegedim Rx thinks it has
provided just that with a recent
The study focused on the system
house's Message Dynamics service,
which sends a text or calls patients
when their repeat prescription is due.
Patients are reminded when their
repeat prescription is due and asked
if they would like it to be requested
The study, by the University of
Surrey, analysed over 10,000
anonymous prescription records
from 217 patients, comparing
compliance in collecting prescriptions
when they were needed before and
after patients started using the
messaging service. The researcher
concluded the messages significantly
improved patient compliance: the
numbers of treatment days
dispensed to previously under-
compliant patients rose, while those
dispensed to previously over-
compliant patients were reduced.
The study found that on average
pharmacies saw a 14 per cent
increase in dispensing to the patients
- welcome news for any struggling
If patients do not need their
repeat, they are asked to leave a
message, which the pharmacist can
listen to at any time, explaining why
they do not want it. This could
enable pharmacists to provide
Simon Driver, Cegedim's
managing director, says he believes
the research shows pharmacists can
help boost medicines adherence, as
getting the medicine into patients'
houses at the right time must be a
first step in compliance. "Give
people the right medicine at the
right time... it's such an obvious
thing," he says. Experts agree this
could be the case, although they
caution that the service would not
solve adherence problems on its own.
C+D understands DH research
into why patients don't take their
medicines is undergoing scrutiny.
But, even without this study, it is
clear that for at least some patients,
forgetting about their medicines is a
factor in non-compliance.
Alastair Buxton, head of NHS
services at PSNC, says for some
patients there is an issue around not
collecting their prescriptions
correctly. While improving this
would be useful, he cautions: "There
are even more complex issues with
people who collect them but still, for
a myriad of reasons, don't take them."
Professor David Taylor of the
School of Pharmacy, University of
London, also agrees there is
"something to be said" for Mr
Driver's argument that the
messaging service can boost
compliance, although he questions
whether it would be more useful to
intervene specifically at the
beginning of treatment regimes.
The text messaging service could
logically go one step further and
remind patients by text to actually
take their medicines. But Mr Buxton
says this might still not be enough to
convince those patients who don't
take their medicines for complex
Despite some limitations, Mr
Driver says he hopes the research
could be used to help negotiate
services for pharmacy in this area, by
demonstrating the sector can have
an impact. "If you've got these
adherence problems and hospital
admissions, to me the obvious route
for any government must be help
pharmacists to manage medicines,"
And experts are unanimous in
their view that studies like this
where data shows community
pharmacy services are effective, are
vital to secure such help. Mike
Holden, chief officer of Hampshire &
Isle of Wight LPC, says: "Sometimes
commissioners have to go on blind
faith that we can deliver a service.
We need to create more evidence...
it's very powerful."
With studies such as Cegedim's
happening more and more at a local
level though, momentum to gather
this evidence seems to be building.
And with developments such as
RPSCB guidance on advancing
pharmacy research expected shortly,
perhaps the only way to go is up.
its medicines adherence top of agenda
PSNC has said national services,
such as those to slash medicines
waste and improve patient
adherence, will be the "main focus"
in the coming months.
Such services were essential to
overcome "very poor" commissioning
in some areas, PSNC chief executive
Sue Sharpe told the Avicenna
Conference in Kerala this week.
Mrs Sharpe hinted at progress on
developing a service to help patients
when they are first prescribed a
medicine for a long-term condition.
She said: "The ability for pharmacists
to target waste of medicine is a key
area for future development. I am
very hopeful we will develop a new
service, commissioned nationally, for
that first prescription."
But with the current mechanism
of funding rewarding higher volumes,
Mrs Sharpe told C+D it could be
"really difficult" to develop a service
to reduce waste. To do this, she said,
funding would need a radical
overhaul to shift away from volume
and reward patient services. "We
need to move away from the
vulnerability we have over the
number of pieces of paper a GP
chooses to issue [governing
funding]," she said.
Mrs Sharpe added that
developing adherence services and
a new funding model that would
pay pharmacists to make sure
patients get the most out of their
medicines would be a 'win-win' for
the NHS. CC
Welcome to a world of
allergic rhinitis relief...
(Please refer to the full Summary of Product Characteristics before prescribing)
Avamys'Y Nasal Spray Suspension (fluticasone furoate 27.5 micrograms /metered spray) Uses:
Treatment of symptoms of allergic rhinitis in adults and children aged 6 years and over Dosage and
Administration: For intranasal use only, AMts: Two sprays per nostril once daily (total daily dose, 110
myograms). Once symptoms controlled, use maintenance dose ol one spray per nostril once daily (total daily
dose, 55 micrograms). Reduce fo lowest dose al which effective control of symptoms is maintained. (Mien
aged 6 fo )) years: One spray per nostril once daily (total daily dose. 55 micrograms) If patent is not
adequately responding, increase dairy dose to 1 10 micrograms (to sprays per nostnl. once daily) and reduce
back down to 55 microgram daily dose once control is achieved Contraindication: Hypersensitivity to active
substance or exdpients Side Effects: Systemic effects of nasal corticosteroids may occur, particularly when
prescribed at high doses lor prolonged periods Very common epistaxis Epistaxis was generally mild to
moderate, with incidences in adults and adolescents higher in longer-term use (more than 6 weeks). Common
nasal ulceraton. Rare: hypersensitivity reactions including anaphylaxis, angioedema, rash, and urticaria.
Precautions: Treatment with higher than recommended doses of nasal corticosteroids may result in clinically
significant adrenal suppression. Consider additional systemic corticosteroid cover dunng periods of stress or
elective surgery Caution when prescribing concurrently with other corticosteroids. Growth retardation has been
reported in children receiving some nasal corticosteroids at licensed doses Monitor height of children
Consider referring to a paediatnc specialist. May cause irritation of the nasal mucosa Caution when treating
patients with severe liver disease, systemic exposure likely to be increased. Nasal and inhaled corticosteroids
may result in the development of glaucoma andJor cataracts Close monitoring is warranted in patients with a
change in vision or with a history of increased intraocular pressure, glaucoma and/or cataracts Pregnancy
and Lactation: No adequate data available. Recommended nasal doses result in minimal systemic exposure.
It is unknown if fluticasone furoate nasal spray is excreted in breast milk. Only use rf the expeded benefits to
the mother outweigh the possible nsks to the foetus or child. Drug interactions: Caution is recommended
when co-administenng with inhibitors of the cytochrome P450 3A4 system, e.g. ketoconazole and ritonavir.
Presentation and Basic NHS cost: Avamys Nasal Spray Suspension. 120 sprays: £644 Marketing
Authorisation Number: EU/1/07/434/003 Legal category: POM PL holder: Glaxo Group Ltd. i
Last date of revision: January 2010
Adverse events should be reported. Reporting forms and information can be found at
www.yellowcard.gov.uk Adverse events should also be reported to GlaxoSmithKline
on 0800 221 441.
Avamys' is a
trademark of the GlaxoSmithKline group of companies.
1. Fokkens WJ, Jogi R, Rernartz S el a/. Once daily fluticasone furoate nasal spray is effective in
seasonal allergic rhinitis caused by grass pollen Allergy 2007. 62 1078-1084.
2. Kaiser HB, Nacleno RM, Given J ef al Fluticasone furoate nasal spray, a single treatment option for
the symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol 2007. 1 19(6) 1430-1437
3 Jacobs R Martin B Hampel F el s! E K e:'";er-;s c ; J :.5S"e HOyg jnce :a . "
treatment of nasal and ocular symptoms ot seasonal allergic rhinitis in adults and adolescents
sensitized to mountain cedar pollen. Cun IWed Res Opm 2009. 25(6) 1393-1401
4, Vasar M, Houle R Douglass J el al Fluticasone furoate nasal spray effective monotherapy for
symptoms of perennial allergic rhinitis in adults/adolescents Meigt Aslfima Proc 2008, 29 313-321
5 Avamys Summary of Product Charactenstics 2010
6 Berger WE, Godfrey JW, Slater AL Intranasal corticosteroids the development ol a drug delivery
device for fluticasone furoate as a potential slep toward improved compliance. Expert Opm Drug DA
2007: 4(6): 689-701.
7 Berger W. Godfrey JW. Grant AC et al Fluticasone furoate (FF) nasal spray - development of a
next-generation delivery system for allergic rhinfe. J Allergy Clin Immunol 2007, 119(1 Suppl) S231
8. Godfrey JW, Granl AC, Slater AL. Fluticasone furoate (FF) nasal spray - ergonomic considerations
for a next generation delivery system J Allergy Clin Immunol 2007, 1 19(1 Suppl) S230
© GlaxoSmithKline group of companies 201 0.
Code UKjFF7OOO8.n0 Date of preparation: February 2010
Allen & HANBurrvs
Check out what's on TV
ENTERIC-COSTEO - te ^«
Actavis has extended its range of
prednisolone EC tablets with larger
The two strengths, 2.5mg and
5mg, now come in two new pack
sizes containing 30 and 100 tablets.
Actavis says the wider range of
pack sizes will provide dispensers
with additional options, along with
increased customer choice,
depending on patient preference for
a single dose or divided daily dosage.
The range is available from all
Accumulator wholesaler partners.
See C+D Monthly
Pricelist or www.cddata.co.uk
Tel: 0800 373573
Ny tol in TV
Nytol will be on TV until April 2011
in a £1 million sponsorship package
with Sky's Gold TV and Watch TV.
The brand will be on air every
evening from Sunday to Thursday on
Watch and every Sunday on Cold.
CSK says the initiative is designed
to create long-term exposure for
Nytol on channels that reach the
brand's target audience.
The animated campaign has been
developed by Wallace and Gromit
creator Aardman Studios. It features
Nytol character Joan who plays a
scriptwriter, with different voiceovers
to keep the campaign fresh.
Tel: 0845 762 6637
Bonjela has mouth ulcers covered
with launch of new treatment
Reckitt Benckiser has
new treatment for
mouth ulcers in its
Complete Plus is
create a protective
barrier to protect
mouth ulcers for up
to four hours,
soothe pain and aid
the healing process.
The gel comes
with a soft precision
for accurate and
The applicator can
back into the bottle a
for the next application with no
need for rinsing or
sterilising, according to
The company says
the product can help
treat minor ulcers but
if an ulcer is causing
or has lasted for more
than three weeks,
customers should see
their G P.
The product should
not be used on ulcers
larger than 1cm and is
only suitable for use
from 16 years.
go directly Price and Pip code:
fter use ready £7.99/1 0ml (100 applications),
• Bonjela is the market leader
in the £21.6 million adult
mouth ulcer category with a
45 per cent value share (AC
Nielsen MAT February 2010).
• Minor ulcers account for 80
per cent of all mouth ulcers
and are more common among
women and people who are
aged under 40 (www.nhs.uk)
Tel: 01482 326151
Spring makeover for Power Health supplements
Power Health is introducing a
fresh new look for its health
food supplements this
Power Health tablets
and capsules will now be
presented in eye-catching
red pots with gold hinge
guard (tamper evident)
lids. Some powders in the
range will also be
supplied in the same
Five new label styles help
differentiate between the
supplement categories across
Power Health is also relaunching
Memory Lane, which is claimed
to be a brain-boosting supplement
marketing campaign until June.
In-store promotions are planned
for later this year.
that can enhance mental ability in
three weeks, and Phytosterols,
which has been formulated to help
The new packaging will be
supported with a national PR and
Prices Memory Lane
Pip codes: See C+D Monthly
Pricelist or www.cddata.co.uk
Power Health Products
Tel: 01759 302595
Check out what's on TV
Red Kooga springs into action
Vifor Pharma (Potters Ltd) is
supporting its Red Kooga ginseng
brand with an advertising campaign
in women's lifestyle magazines this
spring. The campaign is targeted at
busy women with hectic lifestyles.
A second burst of women's
magazine advertising is planned for
September and October to coincide
with the seasonal uplift in VMS
sales. PR activity for the brand
includes regional radio interviews
with lifestyle coach Rebekah
The new marketing drive follows
the launch of four additions to the
Red Kooga range earlier this year:
Korean Ginseng capsules, Korean
Ginseng with Multivitamins &
Minerals, Korean Ginseng &
Ginkgo Biloba and Natural Energy
Release (previously known as Red
A new consumer website for the
brand - www.redkooga.co.uk - has
also been launched.
Product deals for independent
pharmacies are available from the
Ceuta Healthcare salesforce.
Price: from £2.99/10 tablets
Natural Energy Release to
1 -- --- I
£9.49/32 tablets Ginseng and
Pip codes: See C+D Monthly
Pricelist or www.cddata.co.uk
Tel: 01202 780558
What do you think?
to make new friends in high places
I CONTACTED THREE
CANDIDATES, AND BEFORE
YOU COULD SAY PHOTO
OPPORTUNITY THEY WERE
BANGING ON THE DOOR J
It's not often that the pharmaceutical press
resembles the daily tabloids, but the headline
"Murky double life leads to three-year jail term"
featured prominently last week. We've always
sought a high profile for the profession, but I think
the idea was for the 'face of pharmacy' to have the
Rx Factor not the Sex Factor. Sadly, the many
jokes doing the rounds about "the only pharmacist
who hasn't got a drug supply problem is Charles
Butler" belie the potential damage this man may
I don't mean to the 'image of the profession' -
after all, pharmacists are not exactly known for
being racy or exciting, and none of us expects a TV
soap opera or a drama to be set in a pharmacy
because it would be so bloody boring. Actually,
having the odd libertine colleague allows me to
suggest to mates in the pub that I don't spend
every night in bed with just a cup of cocoa and
No, more important is the loss of a prominent
and previously respected supporter at the heart of
government - or at least as close as we have had
Why is that important? Well, which of these
headlines do you prefer: "Pharmacy saves NHS
£1.8bn" or "Pharmacy made £1.1bn excess profit"?
Both of these statements are true, according to a
National Audit Office report, and the DH has
pledged to consider its recommendation that
include reducing PSNC's role, and removing such
retained profit that even the NAO admits it
could threaten the viability of some pharmacies.
Although "pledge to consider" really just means
"we'll think about it" in Civil Service speak, the
problem is the NHS is a world governed on the
basis of executive summaries, and the spin placed
We all remember the expression: "It's not what
you know but who you know", and if ever
pharmacy needed friends in high places, it's now.
Those friends can bring all your birthdays and
Christmases in one - as the GPs found in their new
contract - or such influence as brought the OFT to
bring about the control of entry exemptions.
So now is the time to make friends with
parliamentary candidates, who are in the pre-
election desperate stage. I recently contacted
three of mine, and before you could say "photo
opportunity" they were banging on the door. We
have spent too long developing these political
links, with the all-party pharmacy group, and
C+D's own Building Bridges campaign with MPs,
to throw it all away now.
But, if the NAO persuades the DH that it's
worth the loss of a few little backwater shops
to cut the cost of pharmacy by a quarter, it could
be a case of too little, too late, if we've failed
to convince our elected representatives of our
Professionalism means doing the right thing
What does professionalism mean to
you? Someone told me once that
professionalism is about doing the
right thing when no one's looking. I
like that idea. It captures the
essential point that professionalism
is not something imposed from
outside - by regulators say - but a
set of values that only have meaning
if they come from within the
individual, and the profession of
which they are part.
In that sense I'd argue that
professionalism is the truest form of
goes to the heart of everything you
do, including the way you behave,
your code of ethics, the way you
treat people. In short, it is an
attitude of mind. So, where does the
regulator come in?
In the 21st century the professions
are all faced with the need to maintain
their relevance and standing against
the background of a rapidly
changing society. One definition of a
profession is "a group of individuals
with specialist knowledge and skills
bound by a code of ethics working in
tacit agreement with society where
the relationship is one of trust
between the public and the
practitioner". This might be
threatened as an increasingly diverse
and less deferential society finds it
harder than ever to give the tacit
agreement which permits the
. relationship to thrive.
I firmly believe that this is where
the 21st century regulator comes
into its own. It is in the position of
being able to offer independent
assurance to the public. In
supporting areas of unchanging
professionalism - competence,
integrity, honesty, altruism - and
by providing a code of ethics that
demonstrates accountability and
openness whichever way it is viewed,
the modern regulator can exercise
independent judgement fundamental
to building and maintaining
public trust and confidence.
This is not just about assuring
minimum standards and dealing
with problems, either. Lurid
reporting of fitness to practise cases
may grab the headlines, but
regulation is just as much about
helping to move standards forward
and enabling responsible innovation
as it is about professional discipline.
The creation of the GPhC is part
of a programme of reforms focused
on trust, assurance and safety. The
trust that patients and the public
place in pharmacists and pharmacy
technicians, and in pharmacies,
can and should be underpinned
by an independent assurance, from
a body with no pharmacy or
government axe to grind, about the
safety and standards of the care and
services on offer. That's good for
patients and the public and, I'd
argue, for the profession.
Duncan Rudkin is chief executive
and registrar of the GPhC
4 REGULATION IS AS
FORWARD AS IT
One-stop accredited pharmacist training.
MURs, public health, pharmacy
management and near-patient testing at
or phone 0207 921 8425.
Helping your patients
to manage their
How well do you know
the rules on English
proficiency for foreign
Jobs for the girls
is pharmacy? We talk
to women who made
it to the top
C+D Awards 2010
It's been a tough job,
say the judges, but a
record level of entries
is down to 69 finalists
your OTC sales
A seven-step refresher
on the basics from
As ethical objections to
hit the news again,
unravels the rules
Benchmark is an accredited training course for
^^^^ dispensary assistants.
Written by a team of experienced community
pharmacists and medical writers, Benchmark
has been mapped to both the Pharmacy
Services S/NVQ2 and the Skills for Health
framework that will supersede the NVQ later
Meets RPSGB requirements for
aff, or to find out more
425. Alternatively visit
Need specific CPD resources? Check out our clinical index
Your weekly CPD revision guide
Motor neurone disease
How pharmacists can help patients manage their symptoms
Motor neurone disease is a cruel
condition; life expectancy is generally
two to five years, and patients can die
within six months of MND symptoms
appearing. There is no cure. This article,
which can form part of your CPD,
describes what can be done to manage
What causes MND?
Progressive degeneration of upper or |
lower motor neurones, or both. There are !
four types of MND, depending on which
neurones are affected, and symptoms
When are drugs used?
To control pain, excess saliva and dry
mouth, and to treat spasticity, cramps
and constipation. Riluzole is the only
drug licensed to treat MND (but only
"the ALS form) and slightly extends
survival time. Breathing Space kits
contain anticipatory medicines to deal
with end-of-life symptoms.
This article (Module 1521) can help in the
following CPD competencies: Gla, Glc,
Steve Bremer MRPharmS
Stephen Hawking, recently retired Lucasian
Professor of Mathematics at Cambridge
University, and author of A Brief History of Time,
is perhaps the most well known person with
motor neurone disease (MND). However, having
survived MND for over 40 years makes professor
Hawking a most unusual case; life expectancy for
most people with MND is two to five years, and
around half die within 14 months of diagnosis.
This is a rapidly progressive disease that kills five
people every day in the UK.
MND is the term applied to a group of related
diseases affecting the motor neurones in the brain
and spinal cord. It leaves people unable to walk,
talk or feed themselves, but the intellect and
senses are usually unaffected.
The disease has a varied presentation and
unpredictable, sometimes rapid, progression.
Onset is insidious, with early symptoms including
stumbling, foot drop, weakened grip, slurred
speech, cramp, muscle-wasting and tiredness.
Some patients may present with acute respiratory
The majority of patients are aged over 40, with
the highest occurrence between 50 and 70, and 50
per cent more men are affected than women. The
incidence is around two cases per 100,000 people
per year - similar to multiple sclerosis. But because
of the rapid progression of MND, the prevalence is
only about seven per 100,000, compared with
around 50 per 100,000 for MS. The incidence of
MND seems to be increasing slightly, although it is
unclear whether this represents more cases or
The disease is characterised by progressive
degeneration of the two types of motor neurones.
Upper motor neurones (UMNs) run from the brain
and down the spinal cord, where they release
neurotransmitters across synapses to the lower
motor neurones (LMNs), which run out of the
spinal cord to specific muscles
If LMNs are affected, the muscles become
weak and floppy. A rippling effect under the skin,
known as fasciculation, may be noticed. This is
caused by different parts of the muscle working
independently. If UMNs are affected, muscles
become weak and stiff.
There is no diagnostic test for MND, so diagnosis
requires the demonstration of clinical signs
affecting both the brain and spinal cord. A variety
of neurological tests are used to exclude other
conditions. Diagnosis is often delayed and can
take more than 16 months from the onset of
There are four types of MND:
Amyotrophic lateral sclerosis (ALS) affects
65 per cent of patients, involving both UMN and
LMN. About two thirds of those affected are male,
mainly aged over 55. It is characterised by muscle
weakness, spasticity, hyperactive reflexes,
emotional lability, fasciculation and weight loss.
Average survival is two to five years from onset
Progressive bulbar palsy (PBP) is a form of
ALS that affects 25 per cent of patients,
predominantly women. Both UMN and LMN may
be involved, but only supplying the head and neck.
This form is characterised by dysarthria (unclear
pronunciation) and dysphagia (difficulty
swallowing). LMN damage causes nasal speech,
regurgitation of food via the nose, tongue atrophy
and fasciculation, and pharyngeal weakness. UMN
damage causes spastic tongue, explosive dysarthria
and emotional lability. Average survival is six
months to three years from onset of symptoms.
Progressive muscular atrophy (PMA) affects
fewer than 10 per cent of patients, predominantly
men, with a younger age of onset. It is mainly due
to LMN degeneration, leading to muscle weakness
and wasting, weight loss and fasciculation.
Average survival is five years plus.
Primary lateral sclerosis (PLS) affects
around 2 per cent of patients. Men are affected
twice as often as women and the onset is usually
after 50 years of age. Only the UMN are damaged,
causing muscle weakness, stiffness of limbs and
increased reflex response. Survival is similar to
normal life span.
Demarcation between the clinical groups is
often blurred. As the disease progresses there may
be considerable overlap, resulting in more
generalised muscle wasting and weakness.
Most (95 per cent) of cases develop for no
apparent reason - so-called sporadic MND.
Genetically linked familial MND accounts for the
remaining 5 per cent of cases, with offspring of an
affected parent having a 50 per cent chance of
being affected. Clinically, the two forms are
Riluzole is the only drug licensed to treat MND.
Nice guidance 1 recommends use of the drug only
in patients with the ALS form of the disease. It
provides patients with a gain in median
tracheostomy-f ree survival time of two to four
months. Despite strong clinical support for its use
in other forms of the disease, riluzole is only
licensed for ALS.
It is thought that excessive stimulation of
glutamate receptors on neurones plays an
Table 1 . The pharmacist's role in motor neurone disease
Advise on medicines use in dysphagia Tablets or capsules should not be crushed or opened.
Liquid formulations can be obtained from specials manufacturers if there is no licensed equivalent.
Advise on drugs and enteral feeding Crushed tablets or opened capsules can block PEG feeding
tubes. Contact the local medicines information unit or manufacturer for the most appropriate
formulation for each drug.
Ensure the patient is in contact with the Motor Neurone Disease Association A wide range
of support and advice is available, from regional care advisers who will carry out home visits, to an
equipment loan service and financial support fund.
Supplying disability aids Patients need equipment such as bath aids, commodes, collars to
stabilise the neck while sitting up, hand rails, wheelchairs, feeding aids, communication aids, walking
sticks, container openers, etc.
Brush upon the various types of enteral feeds If you have a patient with MND keep the
relevant brand in stock. Can you deliver?
Check medication on PMR Are symptoms such as dry mouth or constipation exacerbated by
Breathing Space kits Are they fully stocked with in-date medicines?
Check the local palliative care formulary Ensure relevant drugs are in stock.
important role in the destruction of motor
neurones in MND. Glutamate is a
neurotransmitter that tends to excite motor
neurone cells. Riluzole inhibits the release of
glutamate, decreases firing of motor neurones
induced by glutamate receptor agonists and thus
protects cells from glutamate-mediated damage.
Symptoms and management
This affects 80 per cent of patients eventually. It is
caused by weakness and wasting of the tongue,
lips, facial muscles and pharynx and larynx.
Progressive difficulty with articulation, slurred
speech and loss of volume may lead to anarthria.
Speech and language therapists can advise on
communication strategies, while occupational
therapists can assist with communication aids,
seating and wrist supports.
Between 45 and 64 per cent of patients
experience pain at some time. It may be caused by
muscle cramps, spasticity, stiff joints, skin
pressure or constipation. Muscle cramps are
treated with quinine, diazepam and baclofen. For
spasticity, dantrolene, gabapentin, tizanidine and
baclofen can be used. Simple analgesics are often
ineffective, in which case NSAIDs are preferred.
Physiotherapy can help with joint stiffness.
Botulinum toxin may be used for spasticity and
Opioids are used to relieve the discomfort and
distress of skin pressure. A laxative should always
be prescribed concurrently.
Oedema may be related to restricted activity
and posture or to intercurrent disease, which
should be treated accordingly. Support stockings
to reduce the risk of thromboembolism are
supplied from hospitals and not available on FP10,
but pharmacists can advise on their care and how
to put them on.
Dyspnoea and choking
Dyspnoea caused by weakened respiratory
muscles is a common symptom in later stages but
may occur earlier. It can cause fear, anxiety, panic
and poor sleep. Increased C0 2 levels may cause
headaches, particularly on waking.
Physiotherapists and occupational therapists
can advise on careful positioning, perhaps with the
aid of equipment, breathing exercises and chest
Morphine and diamorphine are used to ease
fear, anxiety and breathlessness. Low dose beta-
blockers such as propranolol lOmg can be used to
reduce lung secretions, although this is an
Choking attacks may be due to aspiration,
impaired respiration or muscle spasm, or stridor
due to acid reflux. Patients and carers can be
reassured that death by choking is rare and that
the final stages of MND are usually peaceful and
dignified. The MND Association's Breathing Space
Kit provides tangible evidence that fears have been
addressed and practical help is at hand. The
Association supplies kits free of charge for named
patients at their GP's request. It contains a
suggested list of medication, including midazolam,
glycopyrronium bromide and diamorphine and
advice on their use in terminal care. The GP must
then supply a prescription for the drugs to be kept
at home in the kit until needed.
Dysphagia and nutrition
Dysphagia is caused by weakness and paralysis of
the bulbar muscles resulting from affected
glossopharyngeal, vagus, accessory and
hypoglossal nerves. Loss of the ability to form a
seal with the lips, chew, propel food with the
tongue, poor or absent swallowing reflex and
failure to close the airway results in drooling,
dehydration and weight loss, and aspiration and
recurrent chest infection.
Percutaneous endoscopic gastronomy (PEG)
should be considered before the effort of eating
becomes exhausting, food and fluid intake is
inadequate, or there is danger of inspiration and
fear of choking.
In most patients excessive saliva is the result of
poor lip seal and/or impaired ability to swallow.
Medication to dry up excessive saliva, mouth
breathing and dehydration may all contribute to
thick tenacious saliva.
Drooling can be limited with tricyclic
antidepressants, atropine, hyoscine (available in
motion sickness remedies) and glycopyrronium.
Dry mouth can be limited with pilocarpine eye
drops 4 per cent given orally two to three drops up
to four times daily (an unlicensed indication) or
artificial saliva preparations.
If saliva is thick and tenacious, flavoured ice
cubes, pineapple, apple or lemon juices can help.
Mucolytics may also be used. These include
papaya fruit, which contains an enzyme that
breaks down the protein in tenacious saliva,
and meat tenderiser powder, which is available
Sphincter muscles are not normally affected by
MND. Altered bowel function, which requires
laxatives, is usually the consequence of forced
inactivity, reduced peristalsis, low fluid intake,
reduced fibre intake or weakness of pelvic floor
and abdominal muscles.
There is some evidence to support the use of anti-
oxidants in MND 2 , the most popular theory being
that motor neurones' own anti-oxidant pathways
may not be working efficiently. Research has
investigated the use of vitamin E, N-acetyl
cysteine, co-enzyme Q10 and vitamin C.
Many people with MND find that some
complementary therapies can help make life more
comfortable and reduce stress. Massage is one of
the most popular, providing benefits such as
improved muscle tone and circulation, improved
digestion and relaxation. Acupuncture,
aromatherapy and reflexology are also used.
Steve Bremer MRPharmS is a freelance
pharmaceutical writer and practising
References and further reading are online at
Download a CPD log sheet that helps you
complete your CPD entry when you
successfully complete the 5 Minute Test for
this Update article online (see p19).
The management of chronic
Sign up for the clinical newsletter at
Motor neurone disease
What are the early symptoms of motor neurone disease
(MND)? Which motor neurones does progressive bulbar
palsy affect? How can excessive saliva be treated?
This article describes the different types of MND. It
includes information about the management of
symptoms such as dysarthria, pain, dyspnoea and
choking, dysphagia and saliva problems, and discusses
the role of the pharmacist
Find out more about MND from the Patient UK
website at http://tinyurl.com/mnd-more-info.
Read the Top Tips on the MND Scotland website at
http://tinyurl.com/mnd-top-tips, which has information
about overcoming everyday problems and may be a
useful resource for patients and carers.
Read the article about MND in general practice on the
MND Association website at http://tinyurl.com/
ybrmqjp, and find out more about Breathing Space Kits
from the same website at http://tinyurl.com/yavrsld.
Read the information about PEG feeding tubes on the
Patient UK website at http://tinyurl.com/peg-feeding
and revise your knowledge of enteral feeds from
Appendix 7 in the BNF.
Are you now familiar with MND and its different types?
Do you know how the symptoms are treated? Could you
give advice to patients and carers?
C minute test
mJ What have you learned?
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Rules on English proficiency
Over refreshments at a meeting of a
local branch of the Royal
Pharmaceutical Society, members are
chatting about general topics.
One says: "What do you think about
the German doctor who came over to
England for the weekend to do after
hours' duties and ended up killing a
patient with a massive overdose of
morphine? I believe it was partly due
to the fact that he didn't understand
English properly. I wonder if something
like that could happen with a
Another answers: "I think it's
possible. I've read in a recent survey
that over 60 per cent of pharmacy
employers said they don't do any
language testing of European job
applicants, and that 40 per cent have
encountered problems that were
potentially related to the language
proficiency of employees."
"But surely," says another, "the
RPSGB must ensure that pharmacists
from abroad are competent in
English before they are allowed to
register here? They couldn't just let
them walk in and start practising.
There must be some rules that would
Another member says: "There
certainly are strict rules for some
overseas pharmacists, at least. I've
got a guy working for me as a
technician who is an experienced
pharmacist from South Africa. But if
he wants to work here as a
pharmacist, he's got to go through
an arduous and expensive re-
qualification process. And although
his first and only language is English,
he's got to pass a language test."
1. How many pharmacists from
abroad practise in Great Britain?
2. Is proficiency in English of
overseas pharmacists tested
before they can practise?
3 What do EU pharmacists have
to do to be registered in the UK?
4. What do non-EU pharmacists
have to do to be registered in
1. Around 500 European pharmacists
register each year and about 200
pharmacists per year from outside
the EU apply.
2. For EU pharmacists, no. The
2005 European Directive on the
recognition of professional
qualifications prevents healthcare
regulatory bodies across Europe
from testing the language
competence of applicants for
membership who have achieved
their professional qualification
within the European Economic Area.
The RPSGB and other health
professions are lobbying to get this
changed. Pharmacists from outside
the EU must pass an English
proficiency examination, and to a
3. They must be an EU citizen
entitled to practise as a pharmacist
in the EU, and in good standing
with their national professional
authority (ie, not currently subject
to any disciplinary sanctions or
4. They have to have a pharmacy
degree that is considered to be of
equivalent standard to a UK
bachelor degree, be practising
pharmacists of good standing in
their own country and pass an
English language test. They must
then undertake and pass a one-
year overseas pharmacists' course
at a British school of pharmacy,
followed by the same one-year
programme as UK pharmacy
graduates, and pass the
This article can help with these
CPD competencies: Glh, G1m, G5f.
See http://tiny url.com/68ox7b
Do you have an idea for a Practical
Approach scenario or would you
like to write one? Email us at:
Following Helen Gordon's
appointment last month
as the first chief
executive of the future
professional body, Zoe
Smeaton asks how
pharmacy is, and talks to
women who have worked
their way to the top
I alk into most community
pharmacies and you'll likely find a
female presence. In fact, the
RPSCB's latest workforce census shows that in
2008, 54 per cent of pharmacists in the
community sector were female. And the number
of female pharmacists on the register has been
increasing - 64 per cent of last year's register
entrants were female. So at first glance the
profession seems to have more of an issue
attracting men than women.
But walk into a meeting of the movers and
shakers and you might just see a different story
unfold. Most of the key representative
organisations, such as the National Pharmacy
Association, the Royal Pharmaceutical Society
(currently) and the Company Chemists'
Association, are headed by men. And although
there are some obvious examples of women who
have made it to the top, in a profession dominated
by women there certainly don't seem to be enough.
Sandra Cidley MP, who previously worked as a
community pharmacist, says: "I would go as far as
to say that community pharmacy is a female
environment dominated by male decision
makers." The trend is repeated in the world of
pharmacy owners, too. Sue Sharpe, PSNC chief
executive, says although a lot of pharmacy staff
are female, "the large majority of independent
pharmacies are owned by men".
But is this really a problem, or do women just
prefer not to rise to the top of the profession?
Certainly there are attractions to remaining an
employee pharmacist for life. Boots and
Lloydspharmacy both confirm that they receive
large numbers of applications from women, and
credit the opportunities available for women in
pharmacy to work flexibly as one possible
explanation. As Ms Gidley puts it: "I worked as
a locum myself. It was a brilliant choice when I
had young children. I could choose when and
how much I worked and was paid reasonably
well to boot."
But Annette Williams, director of the UK
Resource Centre for Women in Science,
Jobs for the
Engineering and Technology, says the trend could
be having a negative impact on the profession. "As
in any industry, if your structures inhibit any
individual from flourishing and developing, then
that industry is missing out on ability," she says. In
other words, if we're not pushing women as hard
as we could be, pharmacy is losing out on talent.
Other industries have recognised this and are
actively doing something about it, according to
Christine Heading, a member of the National
Association of Women Pharmacists' (NAWP's)
In many cases, Dr Heading says, large
companies would be carrying out research to track
the progress of women versus that of men in their
organisation. If women were falling behind they
might offer specialist support, encouraging them
to apply for the top jobs and develop themselves
professionally. "Pharmacy just doesn't realise how
far behind it is," she warns.
It's not all down to the organisations, though,
as the responsibilities that women have outside
work could be putting them off taking those top
positions. Ms Gidley agrees: "I regard myself as
something of a feminist so it may surprise you to
hear me say that - after over 50 years on this
planet - 1 think biology has a lot to answer for...
for many women the need to balance husband,
family and other commitments means they can't
be single minded about the business."
Hesitance from women to take business risks
and put themselves forward for the top jobs is an
issue. Ms Williams of the UK Resource Centre says
it may be because there aren't many women in
these jobs at the moment, so others find it hard to
imagine themselves doing them. "It can affect
their aspirations," she says.
At an institutional level this could be tackled if
companies and pharmacy organisations
showcased female pharmacists who had been
successful in their careers to encourage others to
follow. As Mrs Sharpe says: "It is good to
showcase the pharmacists who have been
successful, who can inspire others."
Dr Heading says moves must also be made by
employers, who could use strategies such as
mentoring and monitoring progress by gender to
identify trends, to encourage women to move up
the career ladder. NAWP is also working hard to
encourage employers to take on women who have
Aim higher - check out the latest vacancies in pharmacy
had a break from work and wish to return. And as
Ms Cidley suggests: "Corporates should look at
their career structures and whether the unrealistic
burdens they can put on management level staff
are deterring women from applying for more
Another option could be to ensure that the top
pharmacy positions can be offered on a part-time
basis, or with flexible hours. This might well make
a difference given women's preference for such
roles - they work on average more than seven
hours less than men per week in pharmacy and
are twice as likely to work part time
After that, though, it will be down to women
themselves to push ahead with their careers.
There are many ways to do this (see box, Eight tips
for women from others in pharmacy) and there is
cause for optimism as women pharmacists are
increasing in number and are younger than their
male counterparts - the average for female
pharmacists is 40, compared with 46 for men.
If this trend continues, and women start to
push their way to the top to inspire their younger
colleagues, then perhaps in a few years pharmacy
can catch up with colleagues in other industries.
INDEPENDENT PHARMACY OWNER
On being in the minority:
"I've been at meetings where I'm the only female there and
I have to work twice as hard and be twice as vocal to
convince people that I'm just as capable as them. Being
involved in the media has helped me, it means people know
On combining owning a business with having a family:
"You can do it, you just need to plan and you need to get the
support of other people."
PSNC CHIEF EXECUTIVE
On whether being a woman has been difficult:
"I am fortunate in having colleagues, both men and women,
who concentrate on doing the job we have to do. I never really
think about it, and I believe we have moved quite a long way
from the days when there was an exclusive male club."
On the advantages of being a woman in pharmacy:
"Most pharmacy customers are women and I try hard to retain
a focus on what they want... so from that point of view, yes, I
think it has been useful."
PHARMACIST AND MP
"I think that women undersell themselves and I know that this
was one of my problems previously. I see this all the time -
good women with lots to offer will talk themselves out of
roles rather than into them."
On women holding back:
"With the top jobs it is not lack of ability, but most of the top
jobs are not 9 to 5 and, particularly if a woman has children,
the pluses of the job would have to outweigh the negative
effect on family and personal life."
WWW. CHE Ml STAN DDR U
C+D AWARDS 10.04.10
C+D is delighted to announce the pharmacists, teams, assistants, technicians
and others who have made it onto the shortlist for the C+D Awards 201
With many of our judges saying it was "extremely difficult" to whittle the record number
of entries down to the 69 finalists, those who made it onto the shortlist for the C+D
Awards 2010, in association with the NPA, represent the very best of pioneering
pharmacy practice. From a chlamydia testing university 'open day' to HPV and hepatitis vaccination,
via robotic dispensing and store redevelopments, the breadth of achievements of our finalists
illustrate just what's so great about community pharmacy.
The finalists will now be invited to attend a glittering awards ceremony in London's Mayfair, where
the winners of the 14 coveted trophies will finally be revealed. To joins us at this prestigious event, see
Book your seat, below. Thank you to all those who submitted such high quality entries and a huge
congratulations to those who made the shortlist - see you at the C+D Awards 2010!
Pharmacy Team of the Year
Sponsored by McNeil Products
• Boots, Bon Accord, Aberdeen
• Dean & Smedley, Ashby de-la Zouch,
• Fishers Chemist, South Norwood, London
• Ledbury Pharmacy, Croydon
• Lloydspharmacy, Sway Road, Swansea
• Midcounties Co-operative Pharmacy,
• Rowlands Pharmacy, Kingston Crescent,
Clinical Service of the Year
Sponsored by Martindale Pharma
• loW PCT, integrated blood screening and
• Lloydspharmacy, alcohol identification
and brief advice service
• Murrays Healthcare, chlamydia testing
university 'open day', Henwick Halt, Worcester
• NHS Westminster, HPV vaccination service
Retailer of the Year
Sponsored by T&R Care
• Baskind Pharmacy, Leeds
e Chemist Direct, London
• Island Pharmacy, Jersey
• Rowlands Pharmacy
• Thackers Pharmacy, Wythenshawe, Lancashire
Pharmacy Assistant of the Year
Sponsored by P&G PharmacyCare
• Jennifer Hutchison, Sainsburys Pharmacy,
Ballymena, County Antrim
• Hazel McConnell, Boots, Omagh, County Tyrone
• Patricia McCaig, Boots, Glasgow
• Doreen Walker, Boots, Bolton
Pharmacy Business Leader of the Year
Sponsored by Actavis
• Jay Badenhorst, Whitworth Chemists
• Kenny Black, Rowlands Pharmacy
• Michael Holden, Hampshire & loW LPC
• John Nuttall, The Co-operative Pharmacy
• Graham Phillips, Manor Pharmacy Group,
Business Development of the Year
Sponsored by GlaxoSmithKline
• Brittania Pharmacy, polyclinic LPS contract,
• Gill Pharmacy, store redevelopment,
• Hodgson Pharmacy, online store and service
development, Longfield, Kent
• Lloydspharmacy, out patient services, Royal
Liverpool & Broadgreen University Hospitals
• Mr Pickford's Pharmacy, store redevelopment,
What last year's
"It's really nice to
get recognition. It's
a big boost to your
confidence and a
Valerie Sillito, C+D Prescriber of the Year
2009 and C+D Community Pharmacist of
the Year 2008
"There have been
lots of new
the interest that the
which has given me
the platform to take
things forward in a
Michael Maguire, C+D Community
Pharmacist of the Year 2009
"If you've got a
higher profile it's
going to improve the
interest in your
Duncan Murray, Murrays Healthcare,
C+D Pharmacy Team of the Year 2009
"A really excellent
batch of applications"
"Very inspiring, I have
JUDGES, C+D AWARDS 2010
fi^flc ijour seat for the event of the year
14 trophies • 1 unmissable night
Wednesday, June 9 • Grosvenor House Hotel, Park Lane, London
Book your seat at the event of the year
10.04.10 C+D AWARDS
"Some interesting and promising examples of pharmacy
innovation in professional practice" judge, c+d awards 2010
Pharmacist Prescriber of the Year
Sponsored by PLUS from GlaxoSmithKline
• Lucia Castagnetti, The Co-operative Pharmacy,
• Colin Dougall, Lloydspharmacy,
• Kaushik Patel, Jaywick Pharmacy,
• Nader Siabi, Pharma Healthcare,
Pre-registration Graduate of the Year
Sponsored by Reckitt Benckiser Healthcare
• Ajith Adai, Chemistree Pharmacy,
• Sarah Buchan, Rowlands Pharmacy, Dalgety
• Jenna Kirley, The Co-operative Pharmacy,
Fauldhouse, West Lothian
• Sharon Lindsay, Boots, St Enoch Square,
• Nupur Shah, Leyton Orient Pharmacy,
• Mark Smith, Lloydspharmacy, Wishaw, Glasgow
Community Pharmacist of the Year
Sponsored by Teva UK
• Rachna Chhatralia, Day Lewis,
• Taseen Iqbal, Modi Pharmacy, Dudley,
• Kevin McDevitt, Crossin Chemist, Belfast
• Graham Phillips, Manor Pharmacy Group,
Pharmacy Innovation of the Year
Sponsored by Ceuta Healthcare
• Doncaster LPC, local quality and outcomes
• Lime Tree Pharmacy, Myrepeats.com, Worthing,
• Lloydspharmacy, Online Doctor Service
• NHS Westminster, HPV vaccination service
• Pinnacle Health Partnership, healthcare
solutions through limited liability partnership,
• Will Chemists, robotic dispensing, Inverurie,
New Pharmacist of the Year
Sponsored by AAH Pharmaceuticals
• Waqas Ahmad, Neils Pharmacy,
• Taseen Iqbal, Modi Pharmacy, Dudley,
• Elen Jones, The Co-operative Pharmacy, Gilfach
Goch, Mid Glamorgan
• Ravi Vaitha, Kamsons Pharmacy, Crawley,
Pharmacy Manager of the Year
Sponsored by Sigma Pharmaceuticals
• Taseen Iqbal, Modi Pharmacy,
Dudley, West Midlands
• Bhavesh Patel, Pharma Healthcare, Canvey
• Zoe Emily Pearce, Sainsburys Pharmacy,
• Elaine Stevenson, Manor Pharmacy
(Medipharmacy), Wallington, Surrey
Pharmacy Technician of the Year
• Sally Atmore, Paydens Pharmacy,
• Sally Clarke, The Co-operative Pharmacy,
• Laura Jones, Fishers Chemist, South Norwood,
• Hicham Makboul, Nashi Pharmacy, Westbourne
• Julie Morran, Rowlands Pharmacy, Walsall, West
• Gemma Sharpies, Lloydspharmacy, Bolton
MUR Champion of the Year
• Keith Howell, Delmergate Pharmacy,
Heme Bay, Kent
• Perry Melnick, Manor Pharmacy, Letchworth,
• Patricia Ojo, Day Lewis, Bromley, Kent
• SamiahTambra, Midcounties Co-operative
Pharmacy, Walsall, West Midlands
Martindale Pharma 8
TEVA UK LIMITED
i5™r?"'i»\fi/?Pt f "f ( OMP4 V/
Book now to avoid disappointment
Book online at www.chemistanddruggist.co.uk/awards
or telephone: 0207 921 8359
SEVEN STEPS "TO...
maximising OTC sales
Jennifer Richardson hears your new merchandising mantra from
Reckitt Benckiser's Trevor Gore
You may think you know how to sell OTC medicines and, as far as the
basics go, you'd probably be right. "The fundamentals of over the
counter selling have not changed," says Reckitt Benckiser sales
development controller Trevor Gore. So that's the four Ps - product,
place, price and promotion. But many pharmacists could do with a
refresher course in what these things actually mean - and, more
importantly, how you should apply them to your pharmacy - Mr Core
believes. Not only that, but he's added three more Ps into the equation
PCTs, public expectation and people. Get these seven Ps right, he says,
and you'll see a boost to your business in terms of both footfall and
OTC sales. "If you merchandise correctly you don't lose people walking
past," Mr Gore says.
First, you must ensure signpost brands are visible in all
categories. "People do react better to brands and they get
more [for example] pain relief. It doesn't make sense to us as
scientists, but it does to the public," Mr Gore says.
And this visibility is important even to those customers who
aren't brand-focused, he adds, explaining: "Mothers may not
buy Calpol, but they need to see Calpol to know they're in the
right place." As well as these leading brands, stock new
products with media awareness, as customers may come in and
ask for them, and ensure key pharmacy medicines with unique
benefits over GSL products are available.
And don't try to do it all. "Pharmacies like to try to stock
everything - but you can't stock everything," Mr Gore says.
Check your EPoS or sales data regularly to work out what sells,
he advises - and be ruthless. "The public finds it easier to shop
when you have fewer products and less clutter," Mr Gore says,
giving the example that there are more than 60 adult pain
relief products - but just 25 of these make up 80 per cent of
pharmacy sales in the market.
Focus on stocking the basics in different pack sizes, he
suggests, adding that if you need to stock a product for a
particular loyal customer that is not popular with others, there
is no need to have it out on display - keep it in a drawer.
"Put the best product in the best place on the shelf," Mr Gore
says. "Don't leave it to chance - as in, 'We'll put these there just
because it fits'." He points to data that shows that on a five-
shelf unit, the biggest proportion of sales is from the middle
shelf, closely followed by the second from top; the bottom shelf
has the lowest proportion of sales. Moving a product from the
bottom to second from top shelf increases sales by 78 per cent;
the reverse relocation decreases sales by 40 per cent.
Of course price is important - but it's not community
pharmacy's USP (unique selling point), says Mr Gore, so don't
give it undue weight in your merchandising mindset. "If you're
just going to sell boxes for money, somebody can do it better
than you and for less money," Mr Gore says. "We have got to
get out of the mindset that [selling medicines] is just a cash
He explains: "It's about adding value not price - it's about
understanding the difference between them." And it's the
customer who decides what good value means to them. Mr
Gore gives the example of diamonds versus water - their
relative value is very much dependent on your perspective and
situation. Imagine trekking through the desert for two days
without the latter, and you'll see what he means.
The two biggest launches for pharmacy last year, Mr Gore
points out, were Alii and Optrex ActiMist, both in double figure
prices at over £30 for the smallest pack and almost £15
respectively. "If [the customers] want them, they'll spend
whatever it takes." All this means you shouldn't be afraid to upsell,
he adds, such as by offering different formats or related products.
Promotions can play a role in customers' purchasing decisions,
says Mr Gore, but make sure you know why you are offering
them. Take time to analyse what is the most effective for your
pharmacy and your customers; is it a certain percentage off the
usual price, BOGOF (buy one, get one free), or BOGSHP (buy
one, get second half price), for example?
The area where pharmacy "can prove its worth", according to
Mr Gore, is in advice for minor ailments. The sector has long
been lobbying for a national minor ailments scheme, but for
now any such service is in local commissioners' hands. Talk to
local GPs to get them on side, Mr Gore advises - in a Royal
College of GPs survey, 86 per cent wanted immediate action to
change the culture of dependency on GPs for minor ailments.
Advice is what the public expects of community pharmacies, Mr
Gore says, and you should offer it with every sale you make. He
remembers, with a shudder, 2008's Which? investigation, which
found "unsatisfactory" advice with a third of pharmacy sales.
"Eight per cent of independent pharmacies didn't ask any
questions when selling medicines - that's a disgrace," he says.
He also issues a plea for pharmacists and pharmacy staff to
remember to ask open questions. "Do something that makes
you different from a hole in the wall or a vending machine."
And advice is where your staff come in, Mr Gore says: "Your
staff are your biggest asset." A simple way to motivate them is
to keep them informed. "I'm always amazed that pharmacy
assistants haven't been told what the new contract is, what
PNAs are," Mr Gore says. "How can you expect your number
one asset to be involved in helping you do what you're going to
do if you haven't told them what the game is?"
And one more thing...
Perhaps we should add another P to pharmacies' merchandising
mantra - presentation. Mr Gore notes with exasperation: "Sometimes
the only thing I can be sure some shops sell are dead wasps - because
their windows are full of them." Trevor Gore was speaking at the
Sigma Conference in China in February
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Full Time Position
Should have NVQ 2/3 or equivalent
Drury's Pharmacy - 01637 872589
CV to Liz Nickels
1 Chester Road, Newquay TR7 2RT
or email firstname.lastname@example.org
Bath and Bristol
•Jill J I ■
Please apply by CV to:
Full time (40 hrs)
busy pharmacy at Berkhamsted (nr Watford),
previous experience an advantage,
excellent rate of pay
tel: 07790 663210 for details
^ email: email@example.com
Accredited courses for pharmacy
Medicine Counter Assistant course
Level 2 for Dispensing Assistants
NVQ3 in Pharmacy Services
Pre-registration Pharmacist Programme
CPD Academy for all support staff
Funded Advanced Apprenticeship
programmes (age restrictions apply)
New for 2010:
• Team leading
Enrol any time and experience our supportive learner
journey with 24/7 helpline and access to learner
For more details see our website or telephone
01 15 9374936.
One of our friendly team is always
available for advice.
01 15 937 4936
Browse jobs, upload your CV and get careers advice
...at the NPA
The NPA has launched an
undergraduate training programme
designed to provide employers with
a structured course for pharmacy
students working in pharmacies
during the summer holiday or as
part-time or weekend employees,
ahead of their pre-registration year.
In two parts, the programme has a
suggested timetable that can be
tailored to the length of time a
student will be working, and includes
MCQs and case studies.
"This interactive and structured
training programme allows the
undergraduate to gain new
knowledge and to implement the
knowledge acquired at university,"
said NPA assistant head of education
and training Sabina Khanom. "The
programme is an ideal platform
for moving onto the provision of
The course costs £125 plus VAT.
For more information, contact NPA
Education and Training on 01727
800402 or training. firstname.lastname@example.org.
The NPA is also offering free
media training this summer. The
day-long course is designed to help
members develop skills for speaking
to both broadcast and print media.
Run by "expert media professionals",
it will be held on June 3 in Belfast
and on June 6 in London. To attend,
... at the MHRA
Three pharmacists have been
appointed to a pair of independent
advisory bodies for medicines
advertising and medicinal products
Medicines regulator the MHRA
and the independent Appointments
Commission have announced 13
appointments to the Independent
Review Panel for Advertising and the
Independent Review Panel for
Borderline Products, which are
served by the same panel of experts.
The seven four-year appointments
include former GlaxoSmithKline
Healthcare director of regulatory,
medical and consumer affairs
Elizabeth Bamford, and consultant in
pharmaceutical development Brian
Whittle. The six two-yeai
appointments included Norgine
Pharmaceuticals' interim medical
affairs manager David Kettle.
Got a burning careers question?
and we'll ask the experts
Religion at work
As ethical objections to providing contraception services hit the
headlines again, Chris Chapman unravels the rules
Religion in the workplace is
a sensitive issue, but one
that's vital for pharmacists
to understand. According to the
2001 census, three quarters of the
population believe in a higher
power. Around seven in 10 are
Christian, 2.7 per cent Muslim, 1 per
cent Hindu and 0.6 per cent Sikh.
It's therefore likely that the majority
of a pharmacy's staff are religious -
and they have rights.
And it's something pharmacy
employers recognise. Boots says it
tries to accommodate religious
beliefs "where practicable", but says
it has to balance the needs of
employees with providing a high
standard of customer care.
Religion in the workplace is
governed by Employment Equality
regulations, which protect
employees against discrimination on
the basis of race, gender, sexual
orientation, age and religion.
Religion is only loosely defined,
and it is up to an individual court to
decide what counts. While the
regulations are primarily to prevent
harassment and ensure equal
opportunities, they can impact on all
areas of work, from dress code to
break times. But perhaps the most
important for pharmacy is the right
of employees to opt out of delivering
a service because of their beliefs.
Pharmacists have the legal right
to refuse to provide a service, such
as emergency hormonal
contraception, because of religious
or ethical beliefs. According to the
RPSGB Code of Ethics, it is up to
individual pharmacists whether they
decline to offer a particular service. If
they do decline, the code says they
must ensure "the relevant persons or
authorities are informed, and patients
referred to alternative providers".
The General Pharmaceutical
Legislation may protect against religious discrimination, but is it always practical?
Council, taking over regulation of
pharmacy this year, has confirmed
this 'conscience clause' will
continue. However, additional
requirements, such as displaying
signs informing customers of the
clause, may be required.
Pharmacists shouldn't try to
dissuade a person from the service
on religious or ethical grounds. "Any
attempt by a pharmacist to impose
their beliefs on a member of the
public seeking professional guidance,
or failure to have systems in place to
advise of alternative sources for the
service required, would be of great
concern to the RPSGB," says a
Another area of contention is
dress code. For example, the Sikh
Federation points out that Sikh
employees have the right to wear
articles of faith at work under the
Race Relations Act, including the
kirpan, a ceremonial dagger.
The religious dress of Muslims
varies, the Muslim Council of Great
Britain (MCGB) says. It recommends
employers ensure any dress code can
accommodate requirements to
prevent indirect discrimination.
The MCGB recommends the dress
code for women should allow the
whole body to be covered except the
face and hands. For men, the body
needs to be covered from navel to
the knees, and employees should be
allowed to grow a beard.
According to a spokesperson for
Boots, it is best to work closely with
employees to ensure any attire
meets the company's brand values.
Employers do not have to give
employees time off for prayers, and
can expect them to pray in their
break. However, the MCGB warns
that it could amount to indirect
discrimination if an employer can
make allowances but refuses, or if
other employees are allowed to take
additional smoking breaks.
Employers do not have to grant
requests to move lunch breaks or
give time to Muslims to break their
fast during Ramadan, but would
need to justify refusing a request
because of a legitimate business
need that cannot be met otherwise.
Employers do not have to make
costly adjustments to provide prayer
space, but if it is possible to provide
a room without an adverse impact
on the business, it could be
construed as discrimination to refuse.
Career tip of the week
"A prepared interviewee will always research the company before attending for
interview, irrespective of how interesting the company seems. Remember the
motto: prior preparation prevents a poor performance!"
From Brilliant job hunting, by Angela Fagan
celebrates 57,666 monthly page impressions
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Contact: Andrew Walker
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the legal prescription
Cost effective specialist legal advice
to independent retail and community
We can assist with buying, selling, merging
and demerging pharmacy businesses as
well as related leases, sales and purchases
of commercial premises
— i— — Solicitors
Hilary D'Cruz or Jas Singh
01543 466 660
Chemist+Druggist remains the clear leader
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*Linda Jones Associates Industry Survey 2009
Marie Stopes International are experts in sexual
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If you would like leaflets about unplanned
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sterilisation call us for a free sexual health pack.
020 7034 2382
LOCU M P H A R M ACIST'S
Your pocket guide to Locum Pharmacy Practice
Contents include: Locum Agencies
Pharmacy Development Group
Salary and Recruitment Guide
Responsible Pharmacist Regulations
For your FREE Copy email: firstname.lastname@example.org
over 12,520 job applications since launch
valuing and selling
over 1 60 years
0121 362 8880 ENGLAND & WALES or
01324 631542 SCOTLAND
HUTCHINGS PHARMACY SALES
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THINKING OF SELLING THIS YEAR?
If you are planning to sell your pharmacy
you should be preparing for it now.
Call us today for a no obligation confidential discussion:
We can provide:-
An up to date appraisal of the market
A free valuation of your pharmacy
W\ A comprehensive list of information and
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[71 Tips on how to achieve TOP price
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For further information please contact
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pharmacy sales & valuations
We have over 900 people on our register, from all over
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your next step.
Call 07767 611774 or email: email@example.com
A C Orme, Cornerstones, Lime Walk, Dibden Purlieu,
Southampton S045 4RB
in partnership with
Springboard: sign up n@w
foi the 2010-1 1 pre-reg
!i:iraiiNjiiiiui!;;4 |pu ^gramme
Springboard is a pre-registration programme offered by
Medway School of Pharmacy in partnership with C+D.
Springboard equips pre-registration students with the skills
and confidence to ensure a smooth transition from pharmacy
graduate to practicing pharmacist.
The Springboard pre-registration training programme consists
of eight study days facilitated and delivered by staff from C+D
and Medway School of Pharmacy covering a wide variety of
topics, enabling students to meet the appropriate competencies
in the RPSCB's student handbook.
Springboard is unique in that by the end of the course the
students will have also completed an accredited medicines
use review training programme, the C+D Counterpart
pharmacy assistant course, the Practice Certificate in Pharmacy
Management course, as well as receiving a subscription to an
online practice exam question website.
Springboard also includes a training day for the
The cost of Springboard is from £1,200 (+ VAT) per student.
For more information phone 0207 921 8413
or email firstname.lastname@example.org
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For further information please contact us:
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AS PART OF OUR SERVICES WE WILL ALSO
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: Turnover compared to other similar clients
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: Long term financial planning
For more information or for a
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Got a story for Postscript?
Online with C+D
"How about pharmacists even finding time
to spend five minutes with a customer
without worrying about the backlog this
will create over the course of the day"
I Amp on the Avicenna survey of independent
contractors. Posted on C+D online.
The top stories last week
1. 'Murky double life' leads to three-year
2. Update module 1519: Managing patients
3. Managing codeine concerns
4. £1k for pricing errors
5. MBE pharmacist Charles Butler jailed for
fraud and drug stash at bondage flat
To post a comment, simply register at
Postscript doesn't often get a letter, so when one
landed on our desk begging for assistance, we
were eager to help. The only problem is, we don't
know the answer.
"Dear sirs," the letter, from Newcastle, began.
"At 90 years of age I haven't much hair left to
dress these days, but over the years I regularly
used Brilliantine in my youth, and more recently
Vaseline hair tonic."
Umm, right. The writer adds that he doesn't like
modern hair gel, and asks where he could get "the
good old liquid (oil)" to slap on his barnet.
Postscript's approach to thatch is pretty much
"get it cut short enough that you don't have to
comb it for a few months", so we don't know But
pharmacists are a helpful sort. Do you know
where our Geordie geriatric can get a squirt or two
of hair oil? There's a prize in it for you if you do.
C+D Reader of the week
t chipmunk-keeping Hampshire pharmacist Sid Dajani, and find
hat horrible present a customer opened on his counter
If you have a bacon sandwich, do you have it
with ketchup or brown sauce? Both, but I am
addicted to Reggae Reggae sauce
What's the best holiday you've ever been
©n? The Seychelles, because of the scenery and
the diving. As an epicure I love its exquisite
edibles and interesting potables.
What's your greatest achievement? My father
moved in after his stroke left him paralysed, with
dysphagia, depression and anorexia. Being a
surgeon he made the worst patient. Through hard
work, resilience, laughter, tears and encouragement
he has his life back and manages our olive farms
in Jordan. My sisters and I are so proud of him,
his greatest achievement is ours too.
What's the strangest request you've had in
your pharmacy? Either inserting a suppository
into an overweight lady who couldn't do it
herself, or having a dirty nappy opened on the
counter and asked if the baby had worms.
What's the best thing on TV at the moment?
Absolutely no idea - the OFF button?
Where is your dream place to live?
Hampshire, where I'm surrounded by wildlife,
countryside and there are lots of places for dog
walks. And I can keep my wolves, peacocks,
chipmunks, chickens and geese in harmony!
Did you belong to any clubs or societies at
university? Loads where there was a party, fun
and laughter to be had! The Chinese, Asian,
Welsh Societies, BPSA, YPC, the Halcyon Society
and the Students Union. And I was a member of
the University of London Union until I became
the first to be banned since 1965!
What should we ask the next interviewee? If
you were a superhero, who would you be?
Calling all pharmacists and technicians. We
want you to be our reader of the week. Email
us at email@example.com
• HH :
@The Web Hunter
The government and the Department of Health
(DH) seem to spend an awful lot of time and
money trying to change the way bad things are
advertised: think about cigarettes, alcohol and
junk food. But in their presumed wisdom, I think
they might be overlooking common sense.
I mean, is it just me, or is anyone else fed up
with reading headlines that say, "Study finds that
being fat is unhealthy" or DH ad campaigns telling
us to drink less and exercise more? I know the
powers that be are trying to do the right thing, but
part of me thinks that the £100 million spent on
the government's Campaign for Smarter Drinking
could have been better spent elsewhere.
And what of the pharmacy PR campaign? How
much of the estimated £26m spent by the DH on
TV ads and the further £25m on radio and print
will be siphoned off to promote pharmacy, and
how should it be spent?
It seems the Labour government is not that keen
on it being spent locally. "Far from ideal," as PSNC
head of NHS services Alastair Buxton described it.
The Tories, on the other hand, are keen on the
local idea (according to Mark Simmonds when we
met him last month). They have also promised to
cut the marketing budget of the DH.
So while I'm keen on the idea of fewer big ads
telling me that to get rid of my spare tyre I should
eat more salads and fewer bacon sandwiches, will
fewer ads telling me about local pharmacy
services really work?
I don't know. But let's hope they apply some
Niall Hunt is C+D's digital content editor;
email him at firstname.lastname@example.org
A social tweet
From evil laughs to snoring, join the debate at
@Squeelaa: @CandDChris seems to be practising
evil laughs. Mwoa ha ha ha haaa.
@CandDChris: @Squeelaa I'm an evil mastermind.
That's why I wear a cape in the office and keep
minions and henchpersons about to fetch cake
@Squeelaa: Proving his evilness @CandDChris has
just hacked an icing Bunny up with a knife. Mwoa
ha ha ha ha harrrrrgh.
@GaryParagpuri: The man sitting opposite me on
the train is snoring loudly while appearing to be
wide awake. Fascinating.
Springboard Pre-registration Training Programme 2010-11
Springboard is an exciting pre-registration training programme, offered in
partnership by C+D and Medway School of Pharmacy.
Springboard covers all aspects of the community pharmacy experience and
assists the trainee in making a smooth transition from student to professional.
The programme consists of eight in-house study days covering:
Responding to symptoms
Law and Ethics
Controlled Drug regulations
Medicines use reviews
Dressings and wound management
Monitored dose units
The NHS and how it works
Influencing your PCT
Auditing your services
Clinical cases using the BNF
Practice exam questions
The programme enables the student to meet the appropriate competences in the RPSGB
pre-registration student handbook, and offers support to pre-reg tutors via a tutor training day
and throughout the year. Students are allocated a nominated personal tutor in addition to their
pre-reg tutor in the workplace.
This programme is unique in that the students have the opportunity to be accredited to
provide medicines use reviews. Additionally students are able to accumulate credits by
completing distance learning courses included in the programme that can be put towards
a postgraduate qualification.
All eight student study days and the tutor day will be held at a central London location.
For more information on the Springboard course, complete the slip below and return to:
Kinna McConochie, 8th Floor, Ludgate House, 245 Blackfriars Road, London SE1 9UY;
Alternatively, call Kinna on 0207 921 8413 or email email@example.com
LJ YES, please send me more information on the Springboard pre-registration training programme
in association with
Medway School of Pharmacy
UBM Medica would like to keep you up to date about our products
and services for healthcare professionals Our emails may also include
information from other carefully selected companies including
promotional materials from pharmaceutical companies that may be of
interest to you Your details WILL NOT be passed on to third parties
without your consent. If at any time you do not wish to receive
information from UBM Medica, please tick this box □
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The fastest acting
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ALLEROY kc"- tJj
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Can be taken up to 3 times a day if required 2
1 Acrivastine (Benadryl Allergy Relief)
Non-sedating antihistamine |
Chlorphenamine (Piriton 1 -')
ALLERGY & CONGESTION RELIEF
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Contains Acrivastine + Pseudoephedrine
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Win the war against allergies
Benadryl Allergy Relief Product Information:
Presentation: Acrivastine 8 mg capsules. Uses: Allergic
rhinitis. Also chronic idiopathic urticaria Dosage: Adults
and children aged 12-65 years: one capsule up to
3 times a day. Contraindications: Hypersensitivity to
acrivastine or triprolidine. Significant renal impairment.
Precautions: Caution when engaging in activities which
require mental alertness until familiar with response
to drug. Concomitant use of acrivastine with alcohol
or other CNS depressants may produce additional
impairment. Caution when taking with ketoconazole,
erythromycin or grapefruit juice. Pregnancy &
lactation: Not recommended. Side effects: Rarely
drowsiness. RRP (ex -VAT): 12s £4.35, 24s £7.55
Legal category: 12s GSL, 24s P. PL holder: McNeil
Products Ltd, Foundation Park, Maidenhead, Berks, SL6
3UG. PL no: 1 2s 1 551 3/01 28, 24s 1 551 3/0035. Date
of prep: April 2008
Benadryl Plus Capsules Product Information:
Presentation: Acrivastine 8mg and pseudoephedrine
60mg capsules. Uses: Symptomatic relief of allergic
rhinitis. Dosage: Adults and children 12-65 years:
One capsule as necessary, up to three times a day.
Contraindications: Hypersensitivity or intolerance to any
of the ingredients or triprolidine. Severe hypertension,
severe heart disease or significant renal impairment;
patients who have taken MAOI's in the preceding 14
days. Concomitant use with furazolidone. Precautions:
Diabetes, hyperthyroidism, heart disease, hypertension,
glaucoma or prostatic enlargement. Advise patients not to
undertake tasks requiring mental alertness whilst under
the influence of alcohol or other CNS depressants. Effects
of alcohol or other CNS depressants may be enhanced.
Patients taking sympathomimetics, antihypertensives,
and tricyclic antidepressants Pregnancy & lactation:
Not recommended Side effects: Rarely drowsiness,
CNS excitement; occasionally skin rash, or urinary
retention in men. RRP (ex-VAT): 12s £4.99 Legal
category: P PL holder: McNeil Products Ltd, Foundation
Park, Maidenhead, Berks, SL6 3UG. PL no: 1 551 3/001 7
Date of prep: April 2008
1 . Nielsen L et at Allergy 1 994; 49; 630-6.
2. Benadryl Allergy Relief SmPC (www.emc.medicines.
3. Brogden RN, McTavish D. Drugs 1991 ; 41(6);
4 Slater JW, Zechnich AD, Haxby DG. Drugs 1999; 57(1)'
5. Martindale: The Complete Drug Reference. 36th Ed
Piriton* is a registered trade mark
of the GlaxoSmithKline group
of companies McNeil )